A Case of Intertrochanteric Valgus Osteotomy for Delayed Presentation of the Paediatric Post-Traumatic Coxa Vara After Neck of Femur Fracture

Abstract

Background: Coxa vara in children is a rare but functionally disabling complication following femoral neck fractures, often arising from malunion or growth disturbances. Correction requires addressing both mechanical alignment and physeal orientation to prevent recurrence. This report highlights a successful intertrochanteric valgus osteotomy using a proximal femoral locking plate in a young child with post-traumatic coxa vara.

Case Presentation: A 4-year-old girl presented with limping and right hip pain two months after a fall. Radiographs revealed a neck-shaft angle of 80° on the affected side, confirming coxa vara secondary to malunited femoral neck fracture. Intertrochanteric valgus osteotomy with proximal femoral plate fixation was performed. Postoperative radiographs showed improvement of the neck-shaft angle to 110°, limb lengthening by 1 cm, and correction of deformity without rotation malalignment. Early quadriceps exercises and partial weight-bearing were initiated postoperatively. The plate was removed at 9 months following radiologic union. At one-year follow-up, the child exhibited a normal gait, pain-free hip motion, and stable correction, though the Hilgenreiner epiphyseal angle (HEA) remained mildly elevated (~45°).

Conclusion: Intertrochanteric valgus osteotomy with proximal femoral plate fixation offers a safe, reproducible, and effective correction for pediatric post-traumatic coxa vara. However, long-term surveillance until skeletal maturity is essential to monitor recurrence due to persistent physeal malorientation. This case emphasizes the importance of addressing both the neck-shaft angle and HEA for durable correction in growing children.